慢性血栓栓塞性肺动脉高压的治疗进展

Progress in treatment of chronic thromboembolic pulmonary hypertension

慢性血栓栓塞性肺动脉高压主要见于肺栓塞的并发症,特征是毛细血管前性肺血流动力学变化,伴有慢性血栓性肺血管闭塞。其症状缺乏特异性,3个月以上的规范抗凝治疗后,影像学有肺血栓栓塞的证据,经右心导管证实存在肺动脉高压可做出诊断。肺动脉内膜剥除术是首选的治疗方法。利奥西呱是目前唯一被美国食品药品管理局批准用于不能手术或肺动脉内膜剥除术后持续性肺动脉高压的慢性血栓栓塞性肺动脉高压患者的靶向药物。除药物治疗外,球囊肺动脉成形术是治疗不能手术患者的有效手段。

Chronic thromboembolic pulmonary hypertension,a consequence of pulmonary embolism,is characterized by precapillary pulmonary hemodynamic parameters with chronic thrombotic occlusion of the pulmonary vasculature.Its symptoms are not specific.If there is not only evidence of pulmonary thromboembolism,but also the presence of pulmonary hypertension,chronic thromboembolic pulmonary hypertension can be diagnosed by the right heart catheter after at least three months of effective anticoagulation.Pulmonary endarterectomy remains the preferred therapy.Riociguat remains the only approved medical therapy by FDA for chronic thromboembolic pulmonary hypertension patients deemed inoperable or with persistent pulmonary hypertension after pulmonary endarterectomy.In addition,balloon pulmonary angioplasty may be an effective treatment for patients with inoperable lesions.